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Complications from cradle cap
What is known is that cradle cap sometimes stops being a harmless, temporary, cosmetic problem and becomes a mildly serious medical problem. It is important to know if and when your child’s cradle cap changes from a harmless disease to a problem that requires medical attention.
The problem is that cradle cap can look like a number of other skin diseases of the scalp. Cradle cap can be confused with psoriasis, fungal infections, eczema, and even scabies. In addition, there are a number of less common skin disorders that also look like cradle cap. The big difference between these other disorders and cradle cap is that the skin itself is only mildly affected in cradle cap (in most cases). Even when the scalp is severely affected by cradle cap, the skin looks reasonably healthy underneath the growth. When the scales are removed, the skin should not be red or inflamed.
Identifying complications of cradle cap first requires that you know the more common treatments of cradle cap, since treatment can sometimes lead to a complication. The most common and safest way to treat cradle cap is to treat the infant’s scalp with something that will dissolve and loosen the scales. In most cases this can be accomplished with vegetable, mineral, or baby oil applied to the scalp. The oil should be gently and thoroughly rubbed into the affected area. The vegetable or baby oil can be left on overnight. The hair can then be gently brushed and washed with baby shampoo. The oil dissolves the cradle cap and makes removal with a brush and mild shampoo easier.
Petroleum jelly or petrolatum should not be used on the scalp of infants because it can cause irritation to the scalp. In fact, this is a complication that doctors see in cradle cap: a reddened scalp from the material used to remove the crusts. Redness can also occur if the brushing of the hair and scalp is not sufficiently gentle.
If the oil treatment does not work (or work fast enough for parents) then a physician can prescribe or recommend a dandruff shampoo. This is a rather extreme step and is usually reserved for extensive cases of cradle cap. If a dandruff shampoo is used, ask your doctor about which shampoo is safest for use in young children. The substances in dandruff shampoo can be rather irritating, even to adult scalps. Therefore it is important to use this type of shampoo sparingly and judiciously and to follow the recommendation of a pediatrician.
The use of dandruff shampoo can lead to a complication of cradle cap, in a sense. If the dandruff shampoo is irritating to the scalp, it can cause redness and be uncomfortable for baby. If this occurs, it should be stopped.
It cannot be overstated that the cradle cap scale removal must be done with care and with the least irritating substances possible. It is very important not to break the skin of the scalp. While a scratch is the most obvious sign of a skin breakdown, repeated treatment of certain substances to an area of skin can cause a thinning and a breakdown of the skin’s protective barrier. It may not look like a scratch, but a skin breakdown can lead to the dreaded complication of cradle cap: a skin infection.
Remember that bacteria cover the skin and live there more or less harmlessly all of the time. The skin provides a barrier of protection that keeps the bacteria from causing an infection. The skin is not terribly thick, but in its natural state it is enough to keep us healthy and free of infection.
If the skin is broken, though, the bacteria that live on the skin can migrate into the body now that a portal has been made. Since the skin is thin and bacteria are microscopically small, it does not take much for a skin infection to occur.
Adults and older kids have a robust immune system that is usually able to attend to the site of the cut and kill bacteria as they invade. Unfortunately, the immune system of a newborn is not fully developed at birth. The immune system relies on passive immunity for the most part—whatever antibodies that baby can get from mom. These antibodies need to be able to fight the oncoming infection. This passive immune defense is good but not great. When a break in the skin does occur, a skin infection is quite possible.
The most common serious infection in cradle cap is that of Staphylococcus and Streptococcus bacteria.
These bacteria are simply called Staph or Strep and are present all over the skin. You may have heard of Strep in terms of Strep throat; these bugs are in the mouth and oral cavity, too. Staph and Strep can cause a skin infection known as impetigo. Impetigo is the major, potentially serious complication of cradle cap.
An issue that further complicates the issue is that impetigo can be caused by MRSA (methicillin resistant Staphylococcus aureus) a drug resistant bug that causes rather nasty skin infections. MRSA infections are particularly difficult to treat because of the drug resistance.
Impetigo in infants can be of the bullous or non-bullous type, though bullous impetigo is more common in infants than in older kids or adult:
Non-bullous impetigo starts as a flat red area or red bump that becomes fluid filled within a single day. The fluid-filled disk or bump breaks open which leaves a small crater in its place. The fluid that was contained in the bump dries and forms a honey-colored crust. This honey-colored crust may sound tasty, but it is not at all pleasant and can be itchy. This term honey-colored crust is distinctive for impetigo and is a traditional term used in medical education and in diagnosis since it is reasonably unique and descriptive.
In bullous impetigo, the fluid-filled bumps are much larger overall and the walls of the blisters are thin. When a blister breaks, it releases its thick fluid, which then creates the stereotypical honey-colored crust. While bullous impetigo is more common in infants, it tends to like moist areas like skin folds. Therefore even though the bullous type is more common in babies than adults, as a complication of cradle cap, non-bullous impetigo may be more common.
Regardless of whether impetigo is bullous or non-bullous, it is not a normal part of the cradle cap disease process. If impetigo is present, it means that some other treatment is required. If red bumps occur around a site of cradle cap, it is best to have a doctor look at the lesion. If fluid-filled blisters appear, cradle cap is certainly no longer just cradle cap and is likely now also impetigo.
Once impetigo has taken root, it is a very contagious infection. The contents of the blisters are especially full of bacteria and should be treated as such. Parents should wash hands thoroughly after touching any affected areas. Other children and people that are not primary caregivers should avoid the impetigo in order to minimize the risk of infection. This means keeping baby away from most other people until the infection is under control.
Since impetigo is a bacterial infection, it requires antibiotics in order to treat it. The recommendations regarding antibiotics in impetigo vary. The biggest distinction is whether the disease should be treated with topical antibiotics (a drug placed right on the sore, like a cream or ointment) or treated with a pill taken orally. For various reasons it is often best to treat infants with a topical antibiotic. The biggest reason is that the side effects from topical antibiotics are much less than ones taken orally, especially in young children. Perhaps surprisingly, topical antibiotics may be more effective than oral medicines in impetigo.
Perhaps the most effective topical treatment for impetigo is mupirocin (Bactroban). Mupirocin is available as a 2% ointment and is applied to the lesion three times a day. It is available as a generic drug and is relatively inexpensive, around $60.
The downside to topical treatment for impetigo in infants is that they may not leave the topical treatment in place. Impetigo can be irritating to the skin and the cream can be rubbed away, even inadvertently. Placing a cap or hat on baby may help prevent the topical drug from being rubbed away. Remember, though, that clothes and bedding that has come in contact with an impetigo lesion should be considered infectious. It should be cleaned thoroughly between uses. In fact, it might be best to use white bedding and clothing so that it can be treated with dilute bleach without ruining colors. The bleach will sterilize the cloth. Clothes should be washed normally after bleach treatment.
In severe cases of impetigo, impetigo that causes other complications, or when topical antibiotics are not tolerated, oral antibiotics can be used. Common antibiotics used in impetigo are Amoxicillin/clavulanate (Augmentin) and Cephalexin (Keflex). Treatment with these drugs in kids is adjusted based on weight and usually lasts for ten days.
While impetigo is a complication of cradle cap, impetigo can lead to serious complications as well. Infants with impetigo may have a fever, malaise, listlessness, and weakness. Diarrhea is possible as well. If the infection enters the bloodstream, babies with impetigo may also have pneumonia or bacteria that infect a joint; however, these complications are very rare, thankfully.
Cradle Cap complications in Conclusion
In conclusion, cradle cap is a cosmetic disease that will go away over time in most cases.
In general, cradle cap is relatively harmless to an infant scalp. While it is unsightly, cradle cap (also called seborrhoeic dermatitis) usually resolves on its own after a certain period of time. Despite being a common problem in children, doctors and scientists do not have a good sense of why it occurs. There are some theories, but our understanding of cradle cap is pretty limited. Because it is not entirely clear what causes cradle cap, it is not really clear how to prevent it or how to treat it.
Any treatment for cradle cap should be mild and used carefully. Take care not to break or irritate the skin. Be vigilant for complications which will show up as a redness or bumps on the skin. The feared complication of cradle cap is impetigo, which is highly contagious and needs to be treated with antibiotics.
ABOUT THE AUTHOR: Michael T. Spako is an M.D. who chose to pursue a medical writing career instead of a doctors practice. I am pleased to have him as the principal writer for this cradle cap treatment site, and look forward to his further contributions. Donald Urquhart, Psychologist, Editor.